•Rationale:The nurse should palpate the neck lymph nodes along with the trachea and the frontal and maxillary sinuses when assessing for an upper respiratory tract infection. The nurse should inspect the nasal and tracheal mucosa when

•Bradypnea is the most common sign for a possible
pulmonary embolism.
True or False

•False.

•Rationale: Tachypnea, not bradypnea, is the most common sign for a possible pulmonary embolism.

•Which of the following is the most common surgery for a small apparently curable tumor of the lung?

A.Lobectomy
B.Pneumonectomy
C.Segmentectomy
D.Sleeve resection

•A. Lobectomy

•Rationale: The most common surgical procedure for a small, apparently curable tumor of the lung is a lobectomy. A pneumonectomy is the removal an entire lung. Segmentectomy is not recommended as curative resection of

lung cancer and is a removal of a segment of the lung. A sleeve resection is removal of the cancerous lobes with a segment of the main bronchus resected.

•An initial characteristic symptom of a simple pneumothorax is a sudden onset of chest pain.
True or False

•True.

•Rationale: An initial characteristic symptom of a simple pneumonthorax is a sudden onset of chest pain.

COPD:

•Chronic Obstructive Pulmonary Disease

•A disease state characterized by airflow limitation that is not full reversible (GOLD).

•COPD is the currently is 4th leading cause of death and the 12th leading cause of disability.

•COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these

disorders.

•Asthma is now considered a separate disorder but can coexist with COPD.

inﬂammation of the mucous membranes of the nose; may be infectious, allergic, or inﬂammatory in origin

rhinorrhea:

drainage of a large amount of ﬂuid from the nose

rhinosinusitis:

inﬂammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term “sinusitis”

tonsillitis:

inﬂammation of the tonsils, usually due to an acute infection

xerostomia:

dryness of the mouth from a variety of causes

Epistaxis, a hemorrhage from the nose, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose. Rarely does epistaxis originate in the densely vascular tissue over the turbinates. Most commonly, the site isthe anterior septum, where three major blood vessels enter thenasal cavity:

(1) the anterior ethmoidal artery on the forward part of the roof (Kiesselbach’s plexus), (2) the sphenopalatineartery in the posterosuperior region, and (3)the internal max-illary branches (the plexus of veins located at the back of thelateral wall under the inferior turbinate).Several risk factors are associated with epistaxis.

partial or complete collapse of the lung due topositive pressure in the pleural space

pulmonary edema:

increase in the amount of extravascular ﬂuid inthe lung

pulmonary embolism:

obstruction of the pulmonary vasculature withan embolus; embolus may be due to blood clot, air bubbles, or fatdroplets

purulent:

consisting of, containing, or discharging pus

restrictive lung disease:

disease of the lung that causes adecrease in lung volumes

tension pneumothorax:

pneumothorax characterized by increasing positive pressure in the pleural space with each breath; this is an emergency situation and the positive pressure needs to be decompressed or released immediately

thoracentesis:

insertion of a needle into the pleural space to removeﬂuid thathas accumulated and decrease pressure on the lung tis-sue; may also be used diagnostically to identify potential causesof a pleural effusion

ventilation–

perfusion ratio: the ratio between ventilation and per-fusion in the lung; matching of ventilation to perfusion optimizes gas

exchange

Pleurisy (pleuritis) refers to inﬂammation of both layersofthe pleurae (parietal and visceral).

Pleurisy may develop inconjunction with pneumonia or an upper respiratory tract infection, TB, or collagen disease;after trauma to the chest, pulmonary infarction, or PE; in patients with primary or metastatic cancer; and after thoracotomy.

An empyema

is an accumulation of thick, purulent ﬂuid within the pleural space, often with ﬁbrin development and aloculated (walled-off) area where infection is located.

air trapping:

incomplete emptying of alveoli during expira-tion due to loss of lung tissue elasticity (emphysema),bronchospasm (asthma), or airway obstruction

-antitrypsin deﬁciency:

genetic disorder resulting from deﬁciency of alpha 1

antitrypsin

a protective agentfor the lung; increases patient’s risk for developing panacinar emphysema even in the absence of smoking

asthma:

a disease with multiple precipitating mechanisms resulting

in a common clinical outcome of reversible air-ﬂow obstruction; no longer considered a category of COPD

bronchiectasis:

chronic dilation of a bronchus or bronchi; the dilated airways become saccular and are a mediumfor chronic infection; no

longer considered a category of COPD

bronchitis:

a disease of the airways deﬁned as the presence of cough and sputum production for at least acombined total of 3 months in each of 2 consecutive years; a category of COPD

chronic obstructive pulmonary disease:

disease statecharacterized by airﬂow limitation that is not fullyreversible; sometimes referred to as chronic airway

obstruction or chronic obstructive lung disease

emphysema:

a disease of the airways characterized by de-struction of the walls of overdistended alveoli; acategory of COPD

metered-dose inhaler:

patient-activated medication canister that provides aerosolized medication that the patientinhales into the lungs

polycythemia:

increase in the red blood cell concentrationin the blood; in COPD, the body attempts to improveoxygen carrying capacity by producing increasingamounts of red blood cells

positive pressure applied throughout the respiratory cycle to a spontaneously breathing patient to promote alveolar and airway stability; may beadministered with endotracheal or tracheostomy tube or by mask

controlled ventilation:

mode of mechanical ventilation in which the ventilator completely controls the patient’s ventilation according to

preset tidal volumes and respiratory rate; because of problems with synchrony, it is rarely used except in paralyzed or anesthetized patients

endotracheal intubation:

insertion of a breathing tube through the nose or mouth into the trachea

fraction of inspired oxygen (FiO2):

concentration of oxygen delivered (1.0100% oxygen)

hypoxemia:

decrease in arterial oxygen tension in the blood

hypoxia:

decrease in oxygen supply to the tissues and cells

incentive spirometry:

method of deep breathing that provides visual feedback to help the patient inhale deeply and slowly and achieve maximum lung inﬂation

intermittent mandatory ventilation (IMV):

mode of mechanical ventilation that provides a combination of mechanically assisted breaths and spontaneous breaths

mechanical ventilator:

a positive- or negative-pressure

breathing device that supports ventilation and oxygenation

pneumothorax:

partial or complete collapse of the lung due to positive pressure in the pleural space

positive end-expiratory pressure (PEEP):

positive pressure maintained by the ventilator at the end of exhalation (instead of a normal zero pressure) to increase functional residual capacity and open collapsed alveoli; improves oxygenation with lower fraction of inspired oxygen

postural drainage:

positioning the patient to allow drainage from all the lobes of the lungs and airways

pressuresupportventilation(PSV):

modeofmechanical ventilation in which preset positive pressure is delivered with spontaneous breaths to decrease work of breathing

proportional assist ventilation (PAV):

mode of mechanical ventilation that provides partial ventilatory support in proportion to the patient’s inspiratory efforts; decreases the work of breathing

respiratory weaning:

process of gradual, systematic withdrawal or removal of ventilator, breathing tube, and oxygen

synchronized intermittent mandatory ventilation (SIMV):

mode of mechanical ventilation in which the ventilator allows the patient to breathe spontaneously while providing a preset number of breaths to ensure adequate ventilation; ventilated breaths are synchronized with spontaneous breathing

thoracotomy:

surgical opening into the chest cavity

tracheostomy tube:

indwelling tube inserted directly into the trachea to assist with ventilation

tracheotomy:

surgical opening into the trachea

vibration:

a type of massage administered by quickly tapping the chest with the ﬁnger tips or alternating the ﬁngers in a rhythmic manner, or by using a mechanical device to assist in mobilizing lung secretions

airway pressure release ventilation (APRV):

mode of mechanical ventilation that allows unrestricted, spontaneous breaths throughout the ventilatory cycle; on inspiration patient receives preset level of continuous positive airway pressure, and pressure is periodically released to

aid expiration

assist–control ventilation (A/C):

mode of mechanical ventilation in which the patient’s breathing pattern may trigger the ventilator to deliver a preset tidal volume; in the absence of spontaneous breathing, the

machine delivers a controlled breath at a preset minimum rate and tidal volume

chest drainage system:

use of a chest tube and closed drainage system to reexpand the lung and to remove excess air, ﬂuid, and blood

chest percussion:

manually cupping over the chest wall to mobilize secretions by mechanically dislodging viscous or adherent secretions in the lungs

chest physiotherapy (CPT):

therapy used to remove bronchial secretions, improve ventilation, and increase the efﬁciency of the respiratory